Dialysis Access Surgery: Does Anesthesia Type Affect Maturation and Complication Rates?

Abstract

Creation of an arteriovenous fistula (AVF) is the preferred method of establishing long-term dialysis access. There are multiple anesthetic techniques used for patients undergoing this surgery, including general endotracheal intubation (GET), laryngeal mask airway (LMA), regional anesthesia with nerve blocks, and monitored anesthesia care (MAC) with local infiltration (local/MAC). It is unclear what effect the method of anesthesia has on AVF creation success rate. Our objective was determine if anesthesia type affects success rates of AVF creation defined by complication and maturation rates. A retrospective review was performed in a single-institution, single-surgeon study of 253 patients who underwent AVF creation between January 2003 and December 2010. Patients were cross-analyzed between three anesthesia types (GET, LMA, and MAC) and AVF creation surgeries (radiocephalic, brachiocephalic, and basilic vein transposition AVF creations). No regional anesthesia was performed. Demographic data, including comorbidities and risk factors, were stratified among all categories. Analysis of variance, χ2 testing, and Fisher exact P testing was performed across all anesthesia types and specific operations and measured according to success of AVF maturation and complication rates (including death within 30 days, myocardial infarction within 30 days, respiratory insufficiency, venous hypertension, wound infections, neuropathy, and vascular steal syndrome). There were no significant differences in maturation rate in terms of the three anesthesia types (general, LMA, and local/MAC) for radiocephalic (P = .191), brachiocephalic (P = .191), and basilic vein transposition AVF creation (P = .305). In addition, there were no differences in complication rates between the surgeries and the three types of anesthesia (P = .557). Our study shows that despite anesthesia type, outcomes in terms of maturation and complication rate are not statistically different in AVF creation surgeries. The use of monitored anesthesia care with local anesthesia may improve operative efficiency and therefore may be the preferred method of anesthesia. Future studies can include cost analysis and implications for cost saving measures.